Is my father's prostate report critical?

Q:My father underwent prostate sonography, due to urine restriction (non continuous flow). The report says: Enlarged prostate weighing 46 gm and size 5.04 x 4.11 x 4.24 cm with 60cc of residual urine. We have done PSA of blood and are awaiting result. Is the above problem critical? Is it curable with medicines? What course of action should we take now? My father is 72 years old. He is having CAD with ejection fraction of 33% presently. He underwent a gall bladder laparoscopy last year. Please advise.

A:The prostatic disease is never critical. The decision of treatment is taken by considering 3 parameters:
1. Patients own symptoms i.e. how trouble is he with his urination. In your father's case it seems to be significant. This is the most important parameter.
2. Residual urine as on ultrasound. One can take about 10% of full bladder as normal. One can accept about 25 -30%. In your case, it is not highly significant.
3. Measure of obstruction as by Uroflowmetery test. In your case it is not done. One thing you will observe that size is never a consideration. PSA is important and if significant, it can change the line of treatment. Since your father has significant heart problem, prostatic medicines may not be desirable as they can increase heart rate, which will not be good for him. If all the three factors are in favour of treatment, it should be surgical, not medical since with advancing age he is not going to become younger and surgery will be safer today than after few years.